老年人群跌倒危险因素和康复干预效果的流行病学研究
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摘要
第一部分军队老年人群跌倒患病率及其危险因素的现况调查
目的全面、规范评估军队离退休保健人群跌倒风险，观察和计算该人群跌倒的患病率，探讨老年人综合健康状态和运动功能等多种危险因素与跌倒发生的相关关系，为老年人跌倒相关病因假说的建立及其干预策略的制定提供人群流行病学证据。
方法采用流行病学横断面研究方法，以572例（男性520例，女性52例）60岁以上的军队离退休人员为研究对象，对老年人综合健康状态和跌倒危险因素进行问卷调查和功能评估。调查内容包括社会人口学资料、生活习惯、现病史、服药史、跌倒史、健康生活质量评价、日常生活活动能力、心理状态及体检资料等；功能评估指标包括双侧上肢握力测试、下肢伸膝肌群肌力测试、单腿平衡测试（SLBT）、计时“起立－行走”测试（TUGT）、5次坐立试验（FTSST）、10m最大步行速度测定（MWS）、功能性步行量表（FAC）评定以及分别基于虚弱表型和虚弱指数（FI）的老年虚弱状态评价。由经过统一培训的专业人员进行数据采集。计量资料的描述采用均数±标准差，计数资料的描述采用百分比（%）；利用Logistic回归模型进行单因素及多因素分析，计算比值比（Odds Ratio, OR）及95%可信区间（Confidence Interval, CI）。所有统计分析均由SPSS17.0完成。
结果1.本研究中572例研究对象（男性520例，女性52例），其年龄范围为60~96岁，平均年龄76.93±9.69岁。2.共177人有既往跌倒史者，占总人数的30.94%，其中男性163人，占男性人群的31.35%；女性14人，占女性人群的26.92%。随着年龄的增长，男性和女性跌倒患病率逐渐增加。3.单因素分析结果显示，老年人群跌倒发生的危险因素包括年龄、多病状态、运动功能（TUGT和FTSST）和步态功能（10mMWS）下降、虚弱指数，以及冠心病、心律失常、体位性低血压、糖尿病、呼吸障碍、脑卒中、痴呆、帕金森、外周神经疾病、颈/腰椎病、关节炎、骨质疏松、足病、前列腺疾病、大小便失禁、听觉障碍、昏厥眩晕、压疮病史（p<0.05），保护性因素包括运动史、双下肢平衡功能、伸膝肌力、日常活动能力、平衡信心和SF-12评分(p<0.05)；多因素Logistic回归分析结果显示，老年人群跌倒发生的危险因素包括年龄、IADL失能、步态功能障碍（FAC）、虚弱状态和心律失常、高血压、体位性低血压、呼吸障碍、昏厥眩晕病史（p<0.05），保护性因素包括良好的日常活动能力、伸膝肌力、双下肢平衡功能（p<0.05）。
结论1.本研究的老年人群中，跌倒患病率为30.94%；2.随年龄增加，老年人跌倒患病率明显升高；3.跌倒发生是多种危险因素共同作用的结果，年龄、IADL失能、步态功能障碍（FAC）、虚弱状态和心律失常、高血压、体位性低血压、呼吸障碍、昏厥眩晕病史是老年人跌倒发生的危险因素，良好的日常活动能力、双下肢平衡功能、伸膝肌力是跌倒发生的保护性因素。
第二部分不同干预模式对老年人跌倒及其危险因素的干预效果研究
目的以高跌倒风险老年人为研究对象，初步观察并比较不同的康复训练和干预模式——全身振动训练、家庭平衡训练及/或跌倒知识教育等干预方式对老年人跌倒发生及其危险因素的干预效果，探讨其纳入老年人跌倒综合干预策略的可行性和临床价值，为制定老年高跌倒风险人群的评估和康复治疗方案提供新的临床试验依据。
方法本研究为小样本的随机对照临床试验研究。入选病例来源于第一部分研究中既往发生跌倒的老年人，共纳入120例受试者，随机分为4组，每组30例：1.全身振动训练+跌倒知识宣教组（WBV组）；2.家庭平衡训练+跌倒知识宣教组（BTH组）；3.跌倒知识宣教组（HEF组）；4.空白对照组。干预期3个月，之后进行评估，评估方法同第一部分研究。分类资料采用卡方检验进行比较；计量资料中，满足正态性分布和方差齐性的变量，以均数±标准差（x±SD）表示，两样本均数比较采用t检验，多组间均数比较采用One-way ANOVA检验。若不满足正态性分布或方差不齐的变量以中位数结合全距表示，两样本均数比较和多组间均数比较都用Wilcoxon秩和检验。组间干预效果按照重复测量资料进行统计分析。p<0.05为差异有统计学意义。所有统计分析均由SPSS17.0完成。
结果1. WBV组、BTH组、HEF组和对照组中的受试者分别有30例、26例、28例和29例完成全部干预和随访评估。2.跌倒新发病例：干预后上述各组的跌倒新发病例数分别为2例、1例、2例和4例，组间比较未见显著性差异（p=0.223）。3.运动功能：干预后WBV组在TUG和FTSST完成时间的改善存在显著性差异（p<0.05），BTH组在TUG完成时间存在显著性差异（p<0.05）；4.肌肉力量：各组上肢握力改善不明显，WBV组下肢伸膝肌力增加（p<0.05）；BTH组和HEF组未见显著改变，对照组测试结果略有下降；5.平衡功能：BTH组在平衡功能和平衡信心的改善最为明显（p<0.05）；WBV组在平衡信心的改善显著（p<0.05）；HEF组和对照组未见显著性差异；6.步态功能：WBV组10mMWS和FAC改善显著（p<0.05）；BTH组、HEF组和对照组未见明显改变（p>0.05）；7.日常活动能力和生活质量：WBV组、BTH组和HEF组PCS、MSC、ADL和IADL均有改善，WBV组的改善程度要高于其他组（p<0.05）；8.虚弱状态：干预后WBV组和BTH组虚弱指数下降（p<0.05），HEF组和对照组虚弱指数和虚弱状态表型评分的改善均不显著（p>0.05）。
结论1.结合健康知识宣教的全身振动训练可有效改善老年人下肢运动功能、肌肉力量、平衡功能、平衡心理及患者生活质量和日常活动能力；2.结合健康知识宣教的家庭平衡训练可有效改善老年人平衡功能和运动信心；3.单纯健康教育可有效改善老年人生活质量和日常活动能力；4.同期未进行干预的完全空白对照组在下肢运动功能、肌肉力量、平衡功能、平衡心理及患者生活质量和日常活动能力等指标上未见显著变化。
Objective To observe the distribution and characters of risk factors associatedwith falls, and investigate the prevalence of falls in the veteran elderly.
Methods In a cross-sectional study, subjects were randomly selected from theelderly veteran above60years old in Beijing. The standardized questionnaire andassessments were designed to collected information on the demographiccharacteristics, lifestyle, physical examination, disease history, falls history,activities of daily living, mobility, balance, muscular strength, and frailty status inthe elderly. Epidata3.0and SPSS17.0were used for data management andanalysis.
Results1.572subjects aged60-96years old were investigated;2. The prevalenceof falls in this population was30.94%, and increased from12.59%aged60-69years old to60.34%aged above90years old.3. The analysis of single factor: thedifference of the falls subjects and the non-falls subjects were age, comorbidities,mobility, gait disability and frailty status; and the age, IADL disability; gaitdisability, frailty status, arrhythmia, hypertension, postural hypotension,respiration disorders and syncope were significant in the multiple logisticanalysis.
Conclusion1. The prevalence of falls in the elderly veteran population was30.94%and increased with aging.2. The age, IADL disability; gait disability,frailty status, arrhythmia, hypertension, postural hypotension, respirationdisorders and syncope were risk factors of falls, while the ADL, balance, kneeextensor strength were protective factors of falls in veteran elderly.
Objective To study the effects of whole-body vibration training (WBV), balancetraining at home (BTH), health education of falls (HEF) on the falls andfalls-related mobility function, balance and general health status in veteranelderly.
Methods120older subjects with fall history were randomly assigned to theWBV+HEF group, BTH+HEF group, HEF group and control group. Theintervention period was12weeks. The TUGT, FTSST, lower extremities musclestrength, balance function, balance confidence, ADL, IADL, general health statusand frailty status were assessed at the beginning and after12weeks of theintervention. SPSS17.0was used for data management and analysis.
Results WBV+HEF reduced the time of TUGT and FTSST, improved thebilateral knees extensor strength, balance, ADL, IADL and general healthstatus(p<0.05); BTH+HEF improved the balance ability, balance confidence andgeneral health status(p<0.05); HEF improved the general health status(p<0.05);and No effects were observed in control group(p>0.05).Conclusions WBV, BTH, and HEF are safe and effective in improving thefalls-related mobility function and the general health status in elderly.
目的全面、规范评估军队离退休保健人群跌倒风险，观察和计算该人群跌倒的患病率，探讨老年人综合健康状态和运动功能等多种危险因素与跌倒发生的相关关系，为老年人跌倒相关病因假说的建立及其干预策略的制定提供人群流行病学证据。
方法采用流行病学横断面研究方法，以572例（男性520例，女性52例）60岁以上的军队离退休人员为研究对象，对老年人综合健康状态和跌倒危险因素进行问卷调查和功能评估。调查内容包括社会人口学资料、生活习惯、现病史、服药史、跌倒史、健康生活质量评价、日常生活活动能力、心理状态及体检资料等；功能评估指标包括双侧上肢握力测试、下肢伸膝肌群肌力测试、单腿平衡测试（SLBT）、计时“起立－行走”测试（TUGT）、5次坐立试验（FTSST）、10m最大步行速度测定（MWS）、功能性步行量表（FAC）评定以及分别基于虚弱表型和虚弱指数（FI）的老年虚弱状态评价。由经过统一培训的专业人员进行数据采集。计量资料的描述采用均数±标准差，计数资料的描述采用百分比（%）；利用Logistic回归模型进行单因素及多因素分析，计算比值比（Odds Ratio, OR）及95%可信区间（Confidence Interval, CI）。所有统计分析均由SPSS17.0完成。
结果1.本研究中572例研究对象（男性520例，女性52例），其年龄范围为60~96岁，平均年龄76.93±9.69岁。2.共177人有既往跌倒史者，占总人数的30.94%，其中男性163人，占男性人群的31.35%；女性14人，占女性人群的26.92%。随着年龄的增长，男性和女性跌倒患病率逐渐增加。3.单因素分析结果显示，老年人群跌倒发生的危险因素包括年龄、多病状态、运动功能（TUGT和FTSST）和步态功能（10mMWS）下降、虚弱指数，以及冠心病、心律失常、体位性低血压、糖尿病、呼吸障碍、脑卒中、痴呆、帕金森、外周神经疾病、颈/腰椎病、关节炎、骨质疏松、足病、前列腺疾病、大小便失禁、听觉障碍、昏厥眩晕、压疮病史（p<0.05），保护性因素包括运动史、双下肢平衡功能、伸膝肌力、日常活动能力、平衡信心和SF-12评分(p<0.05)；多因素Logistic回归分析结果显示，老年人群跌倒发生的危险因素包括年龄、IADL失能、步态功能障碍（FAC）、虚弱状态和心律失常、高血压、体位性低血压、呼吸障碍、昏厥眩晕病史（p<0.05），保护性因素包括良好的日常活动能力、伸膝肌力、双下肢平衡功能（p<0.05）。
结论1.本研究的老年人群中，跌倒患病率为30.94%；2.随年龄增加，老年人跌倒患病率明显升高；3.跌倒发生是多种危险因素共同作用的结果，年龄、IADL失能、步态功能障碍（FAC）、虚弱状态和心律失常、高血压、体位性低血压、呼吸障碍、昏厥眩晕病史是老年人跌倒发生的危险因素，良好的日常活动能力、双下肢平衡功能、伸膝肌力是跌倒发生的保护性因素。
第二部分不同干预模式对老年人跌倒及其危险因素的干预效果研究
目的以高跌倒风险老年人为研究对象，初步观察并比较不同的康复训练和干预模式——全身振动训练、家庭平衡训练及/或跌倒知识教育等干预方式对老年人跌倒发生及其危险因素的干预效果，探讨其纳入老年人跌倒综合干预策略的可行性和临床价值，为制定老年高跌倒风险人群的评估和康复治疗方案提供新的临床试验依据。
方法本研究为小样本的随机对照临床试验研究。入选病例来源于第一部分研究中既往发生跌倒的老年人，共纳入120例受试者，随机分为4组，每组30例：1.全身振动训练+跌倒知识宣教组（WBV组）；2.家庭平衡训练+跌倒知识宣教组（BTH组）；3.跌倒知识宣教组（HEF组）；4.空白对照组。干预期3个月，之后进行评估，评估方法同第一部分研究。分类资料采用卡方检验进行比较；计量资料中，满足正态性分布和方差齐性的变量，以均数±标准差（x±SD）表示，两样本均数比较采用t检验，多组间均数比较采用One-way ANOVA检验。若不满足正态性分布或方差不齐的变量以中位数结合全距表示，两样本均数比较和多组间均数比较都用Wilcoxon秩和检验。组间干预效果按照重复测量资料进行统计分析。p<0.05为差异有统计学意义。所有统计分析均由SPSS17.0完成。
结果1. WBV组、BTH组、HEF组和对照组中的受试者分别有30例、26例、28例和29例完成全部干预和随访评估。2.跌倒新发病例：干预后上述各组的跌倒新发病例数分别为2例、1例、2例和4例，组间比较未见显著性差异（p=0.223）。3.运动功能：干预后WBV组在TUG和FTSST完成时间的改善存在显著性差异（p<0.05），BTH组在TUG完成时间存在显著性差异（p<0.05）；4.肌肉力量：各组上肢握力改善不明显，WBV组下肢伸膝肌力增加（p<0.05）；BTH组和HEF组未见显著改变，对照组测试结果略有下降；5.平衡功能：BTH组在平衡功能和平衡信心的改善最为明显（p<0.05）；WBV组在平衡信心的改善显著（p<0.05）；HEF组和对照组未见显著性差异；6.步态功能：WBV组10mMWS和FAC改善显著（p<0.05）；BTH组、HEF组和对照组未见明显改变（p>0.05）；7.日常活动能力和生活质量：WBV组、BTH组和HEF组PCS、MSC、ADL和IADL均有改善，WBV组的改善程度要高于其他组（p<0.05）；8.虚弱状态：干预后WBV组和BTH组虚弱指数下降（p<0.05），HEF组和对照组虚弱指数和虚弱状态表型评分的改善均不显著（p>0.05）。
结论1.结合健康知识宣教的全身振动训练可有效改善老年人下肢运动功能、肌肉力量、平衡功能、平衡心理及患者生活质量和日常活动能力；2.结合健康知识宣教的家庭平衡训练可有效改善老年人平衡功能和运动信心；3.单纯健康教育可有效改善老年人生活质量和日常活动能力；4.同期未进行干预的完全空白对照组在下肢运动功能、肌肉力量、平衡功能、平衡心理及患者生活质量和日常活动能力等指标上未见显著变化。
Objective To observe the distribution and characters of risk factors associatedwith falls, and investigate the prevalence of falls in the veteran elderly.
Methods In a cross-sectional study, subjects were randomly selected from theelderly veteran above60years old in Beijing. The standardized questionnaire andassessments were designed to collected information on the demographiccharacteristics, lifestyle, physical examination, disease history, falls history,activities of daily living, mobility, balance, muscular strength, and frailty status inthe elderly. Epidata3.0and SPSS17.0were used for data management andanalysis.
Results1.572subjects aged60-96years old were investigated;2. The prevalenceof falls in this population was30.94%, and increased from12.59%aged60-69years old to60.34%aged above90years old.3. The analysis of single factor: thedifference of the falls subjects and the non-falls subjects were age, comorbidities,mobility, gait disability and frailty status; and the age, IADL disability; gaitdisability, frailty status, arrhythmia, hypertension, postural hypotension,respiration disorders and syncope were significant in the multiple logisticanalysis.
Conclusion1. The prevalence of falls in the elderly veteran population was30.94%and increased with aging.2. The age, IADL disability; gait disability,frailty status, arrhythmia, hypertension, postural hypotension, respirationdisorders and syncope were risk factors of falls, while the ADL, balance, kneeextensor strength were protective factors of falls in veteran elderly.
Objective To study the effects of whole-body vibration training (WBV), balancetraining at home (BTH), health education of falls (HEF) on the falls andfalls-related mobility function, balance and general health status in veteranelderly.
Methods120older subjects with fall history were randomly assigned to theWBV+HEF group, BTH+HEF group, HEF group and control group. Theintervention period was12weeks. The TUGT, FTSST, lower extremities musclestrength, balance function, balance confidence, ADL, IADL, general health statusand frailty status were assessed at the beginning and after12weeks of theintervention. SPSS17.0was used for data management and analysis.
Results WBV+HEF reduced the time of TUGT and FTSST, improved thebilateral knees extensor strength, balance, ADL, IADL and general healthstatus(p<0.05); BTH+HEF improved the balance ability, balance confidence andgeneral health status(p<0.05); HEF improved the general health status(p<0.05);and No effects were observed in control group(p>0.05).Conclusions WBV, BTH, and HEF are safe and effective in improving thefalls-related mobility function and the general health status in elderly.
引文
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